Thoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy.
Thoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy.
复制标题
DOI：
10.1016/j.athoracsur.2020.06.072
复制
发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Jones DR
中科院分区：
文献类型：
--
作者：
Caso R;Jones GD;Tan KS;Bosl GJ;Funt SA;Sheinfeld J;Reuter VE;Amar D;Fischer G;Molena D;Rocco G;Bains MS;Feldman DR;Jones DR
单独接受一线化疗与挽救性化疗的睾丸生殖细胞肿瘤（GCT）患者胸部转移瘤切除术后的结果仍有待探索。对 1997 年至 2019 年间在一个三级中心因残留 GCT 接受胸部转移瘤切除术的患者进行了回顾性研究。使用多变量 Cox 回归评估与无进展生存期 (PFS) 和总生存期 (OS) 相关的因素。在 251 名患者中，191 名（76%）仅接受一线化疗，60 名（24%）接受挽救化疗。中位随访时间为 3.45 年（四分位数范围，1-7.93）。在原发肿瘤无畸胎瘤、腹膜后淋巴结坏死、血清肿瘤标志物正常/下降的一线患者中，85% (17/20) 出现胸内坏死。在一线患者和抢救患者中，5年OS分别为93%（95%置信区间[CI]，89%–98%）和63%（95% CI，51%–78%；P<0.001），5年PFS分别为69%（95% CI，62%–77%）和40%（95% CI，29%–56%；P<0.001）。 P<0.001）。多变量分析显示，诊断时存在多发性肺部病变（风险比 [HR]，3.01；95% CI，1.50-6.05；P=0.002）和脑转移（HR，4.51；95% CI，2.34-8.73；P<0.001），挽救性化疗（HR，1.85；95% CI， 1.10–3.13；P=0.021）、畸胎瘤（HR，2.68；95% CI，1.50–4.78；P=0.001）和存活恶性肿瘤（HR，4.34；95% CI，2.44–7.71；P<0.001）与较差的 PFS 相关。尽管接受挽救性化疗并随后接受胸腔转移瘤切除术治疗的 GCT 患者的病情更严重且 PFS 更差，但他们可以获得令人鼓舞的 OS。我们的研究结果强调了积极的胸部转移瘤切除术在治疗仅一线化疗或挽救性化疗后残留胸部疾病的 GCT 患者中的不可或缺的作用。
Outcomes following thoracic metastasectomy in patients with testicular germ cell tumors (GCTs) who received first-line chemotherapy alone versus salvage chemotherapy remain unexplored. A retrospective review of patients who underwent thoracic metastasectomy for residual GCT between 1997 and 2019 at a single tertiary center was conducted. Factors associated with progression-free survival (PFS) and overall survival (OS) were assessed using multivariable Cox regression. Of 251 patients, 191 (76%) received only first-line chemotherapy, and 60 (24%) received salvage chemotherapy. Median follow-up was 3.45 years (interquartile range, 1–7.93). Among first-line patients without teratoma in their primary tumor, with necrosis in the retroperitoneal nodes, and normalized/decreasing serum tumor markers, 85% (17/20) had intrathoracic necrosis. Among first-line and salvage patients, respectively, 5-year OS was 93% (95% confidence interval [CI], 89%–98%) vs 63% (95% CI, 51%–78%; P<0.001), and 5-year PFS was 69% (95% CI, 62%–77%) versus 40% (95% CI, 29%–56%; P<0.001). On multivariable analysis, multiple lung lesions (hazard ratio [HR], 3.01; 95% CI, 1.50–6.05; P=0.002) and brain metastasis (HR, 4.51; 95% CI, 2.34–8.73; P<0.001) at diagnosis, salvage chemotherapy (HR, 1.85; 95% CI, 1.10–3.13; P=0.021), teratoma (HR, 2.68; 95% CI, 1.50–4.78; P=0.001), and viable malignancy (HR, 4.34; 95% CI, 2.44–7.71; P<0.001) were associated with worse PFS. Although GCT patients treated with salvage chemotherapy followed by thoracic metastasectomy have more-aggressive disease and poorer PFS, they can achieve encouraging OS. Our findings highlight the integral role of aggressive thoracic metastasectomy in the treatment of GCT patients with residual thoracic disease following first-line only or salvage chemotherapy.
登录
查看更多内容
影响因子：
10.3
作者：
Collette, L;Sylvester, RJ;Kaye, SB
通讯作者：
Kaye, SB
影响因子：
45.3
作者：
Hanna, Nasser;Einhorn, Lawrence H.
通讯作者：
Einhorn, Lawrence H.
影响因子：
45.3
作者：
Rick, O;Bokemeyer, C;Beyer, J
通讯作者：
Beyer, J
影响因子：
9
作者：
Caso, Raul;Jones, Gregory D.;Jones, David R.
通讯作者：
Jones, David R.
影响因子：
9
作者：
Dindo, D;Demartines, N;Clavien, PA
通讯作者：
Clavien, PA